Treatment of severe exacerbation of chronic obstructive pulmonary disease with mask-applied continuous positive airway pressure

Abstract The efficacy of mask-applied continuous positive airway pressure (CPAP) in the treatment of patients with acute severe exacerbations of chronic obstructive pulmonary disease (COPD) was examined. Ten patients with severe exacerbation of COPD who had deteriorated during conventional therapy were treated with face-mask delivered CPAP (+5 cmH₂ O; Downs Vital signs Inc., New Jersey, USA) instead of tracheal intubation and mechanical ventilation. The patients that were selected required mental alertness, intact upper airway reflexes, the clinical signs of dynamic hyperinflation and a positive end-expiratory pressure auto-(PEEP) manifested as expiratory wheeze and grunting. Nine out of 10 patients responded promptly to mask-CPAP with less distress, better oxygenation, lower respiratory and pulse rates. There was no significant change in arterial carbon dioxide tension with mask-CPAP treatment. One patient deteriorated on mask-CPAP and required intubation and mechanical ventilation. Three patients died (none of these patients died during the acute period of exacerbation). It was concluded that Mask-CPAP may be an alternative to mechanical ventilation in the treatment of selected patients with severe hypercapnic exacerbations of COPD.     

In vitro antimicrobial activity of natural toxins and animal venoms tested against Burkholderia pseudomallei

Background  

Burkholderia pseudomallei are the causative agent of melioidosis. Increasing resistance of the disease to antibiotics is a severe problem in treatment regime and has led to intensification of the search for new drugs. Antimicrobial peptides are the most ubiquitous in nature as part of the innate immune system and host defense mechanism.     

Evidence for and against urinary prophylaxis in vesicoureteral reflux

The role of antimicrobial prophylaxis in vesicoureteral reflux (VUR) has come under increasing scrutiny because of better analytical methods in the published literature, knowledge gained from VUR and renal scars diagnosed without preceding urinary tract infection (UTI), and better renal imaging modalities for diagnosing renal scars. A meta-analysis of the five recent randomized studies with a total of 809 patients with VUR diagnosed after UTI reveals a relative risk of UTI recurrence of 0.82 [95% confidence interval (CI) 0.62–1.08; p?=?0.16) with prophylaxis. A meta-analysis of the four studies with a total of 662 patients with UTI with and without VUR evaluated for renal scarring reveals a relative risk of 1.04 (95% CI: 0.84–1.30; p?=?0.69), according to Springer style?> with prophylaxis. However, these observations need to be interpreted with caution because of the limitations with these studies and their heterogeneity for meta-analysis, particularly for renal scarring. More research is needed to validate the role of prophylaxis in VUR diagnosed after UTI, and even more research is warranted to answer the questions regarding antimicrobial prophylaxis across the spectrum of VUR in different clinical settings.     

Disproportionately High Rate of Epileptic Seizure in Patients Abusing Dextropropoxyphene

Dextropropoxyphene (DPP), a weak opioid, is often abused as a psychoactive substance. In this retrospective chart review to document, characterize and put in perspective the often‐obtained history of epileptic seizures in patients with DPP abuse, we analyzed the case files of all patients with DPP abuse registered in our center (a tertiary‐care drug de‐addiction clinic in north India) from May 1, 2001 until April 30, 2007 and those with use of other opioids during the same period. Non‐drug‐related seizures were excluded from analysis. Out of 312 patients with DPP abuse, 63 (20.2%) had epileptic seizures related to DPP use, in contrast to 0.4% –4.2% of other opioid users. The seizures were mostly characterized as generalized tonic‐clonic seizures (87.3%), occurring around two hours following a higher‐than‐usual dose of DPP. Those with seizures had significantly greater duration of DPP use and higher rates of medical comorbidity compared to patients without seizure. Age, duration of use and medical comorbidity were better predictors of seizure than dosage of drug or use of multiple drugs. Thus, DPP‐induced epileptic seizures are common (one in five), and much more frequent than seizures in patients using other opioids. The awareness of this phenomenon has implications for diagnosis and management, as well as for drug regulation policy.     

Quality of life and its correlates in patients with dual diagnosis of bipolar affective disorder and substance dependence

OBJECTIVES: To compare the quality of life (QOL) of patients having dual diagnosis of bipolar affective disorder and substance dependence with those having either diagnosis alone and with healthy controls. METHODS: Cross-sectional assessment of the four groups of subjects was made. Euthymic bipolar patients and those substance dependent patients not in active withdrawal or intoxication were included. QOL assessment was made with the World Health Organization (WHO)-QOL--Bref Hindi version. RESULTS: Total QOL score and scores on all the four domains of WHO-QOL-Bref were significantly lower for the dual-diagnosis (DD) patients when compared with all the other groups. Significant negative correlations were found between (i) the number of days the drug was consumed and the score on the 'general well-being' items of WHO-QOL-Bref (r = -0.31, p < 0.05); and (ii) between severity of alcohol dependence and WHO-QOL total score (r = -0.44, p < 0.01) as well as its 'psychological' domain (r = -0.52, p < 0.05). CONCLUSIONS: The study indicates that bipolar DD patients experience a lower QOL when compared with the other groups studied. Their QOL is affected by the severity of alcohol dependence.     

Pulmonary artery sarcoma: a case report of surgical cure and 5-year follow-up

Pulmonary artery sarcoma is a rare tumor that is frequently misdiagnosed as chronic pulmonary embolism. With heightened clinical awareness and advancement in technology, the diagnosis is now increasingly being made preoperatively. Previous literature has described the disease to be uniformly fatal, with surgical resection as the single most effective modality for short-term palliation. We present the case of a patient in whom pulmonary artery sarcoma was diagnosed preoperatively and who underwent surgical resection with no evidence of recurrence during long-term follow-up, suggesting that early identification and aggressive surgical intervention has the potential to be curative.     

Mass family hysteria: a report from India

The case of a 31-member family displaying mass hysteria in up to 10 members at one time is reported. The mass hysteria emerged in the context of the strong religious and cultural beliefs held by this closely knit family. The varied presentations included somatoform disorder, recurrent vomiting, conversion, dissociative and possession attacks. Two members had bipolar affective disorder that was recognized by the family as a 'medical' illness in contrast to other problems attributed to religiosity. The rarity of mass hysteria in a family and issues related to its medical and social management are highlighted.     

GRAVES' DISEASE WITH ORGANIC MOOD SYNDROME (A Case Report)

A case of Graves'' disease with organic mood syndrome in a 3G year old man is reported. Patient had thyrotoxicosis and developed features of mania while in the hospital which necessitated antipsychotic drug therapy.KEY WORDS: Graves'' disease, ManiaFrank psychotic decompensation occurring in the background of Graves'' disease is an explosive clinical situation as manifestations range from severe manic excitement to total apathy. Although rare, the gravity of such situation warrants energetic intervention on both fronts. One such instance of organic mood syndrome with Graves'' disease is being presented, highlighting the problems encountered in the management.